Costs of Cancer Care: Is the Community Setting Different than the Academic?

Abstract

In 1992, shortly after the election of President William Jefferson Clinton, a government led initiative for health care reform was begun. Driving factors included considerations related to both costs and access - unabated increases in health care costs, accounting for 12% of the Gross National Product, 30 million Americans without health care, employers’ health care contributions continuously rising, and health care insurance plans that were not portable and were difficult or very expensive for individuals with pre-existing illnesses. The Federal health care reform initiative began in 1993 with a series of closed meetings, with a plan presented to Congress in 1994. The Clinton plan called for “managed competition” by health care insurers, health maintenance organizations (HMO’s), and the creation of hospital-physician networks that would compete with one another in the marketplace. A decrease in health care costs would be possible through efficiencies in medical care, decreased administrative costs, reduced variations in care, and improved outcomes. New buzzwords including clinical protocols, continuous quality improvement, total quality management, and managed care were being incorporated into the health care reform lexicon. Despite the tremendous amount of time and effort devoted to the reform package, the Federal initiative failed.